Romania began its transition from communism in 1989, with an extinct industrial base, and a profitable guide unfiting to the needs of the country. The recession of industrial output, service contracts, and the collapse in investment increased as the trade gap extended for a number of years. The recent shortcoming of account remained at 5.4% of the GDP in 1998. By 1989-2002, unemployment increased, many large scale businesses were under government control, yet to tackle the primary issues which empowers the growth of business in a competitive environment (Vlădescu & Scîntee, 2008).
Over the years, according to the world bank, there has been a rise in figures on the Romanian healthcare system, revealing that access to healthcare is biased towards the more privilege classes. In addition, according to Raiffeisen Bank Romania, the ratio of doctors to patients, is two doctors to 1000 of population, below average in Europe. On the account of Romania joining the EU, the availability of medical personnel declined, decreasing access to healthcare services among citizens (Oreste Ross, 2014).
In 2006, the mass media raised awareness by predicting huge emigration of medical doctors and nurses that would threaten the health system. The emigration rate increased by 2007, 1421 medical doctors left the country which affected the most economical deprived area of Romania more than other regions (Suciu, Popescu, & Buzoianu, 2017).
By the end of 2009, the economic crisis begun to impact the Romanian society deeply, including the health system. Furthermore, there were additional obstacles introduced in 2010 for the healthcare professionals, as well as a 25% salary discount. As a result, there was shortage of staff, hence, developments regarding the domestic workforce combined with the emigration of healthcare practitioners became a critical problem in Romania (Galan, Olsavszky, & Vladescu, 2006).
The purpose of these measures is to straight-up a line with the priorities of the strategic partnership. Also, to support the network for the provision of healthcare services (hospitals), increase the services of medical practices increase the availability of primary healthcare at the community level and strengthen governance within the health system. The stakeholder for this responsibility is the World Bank.
LONG TERM MEASURES:-
Strategic management an organizational management activities that is used to set priorities, focus energy and resources, strengthen operations, ensure that employees and other stakeholder are working towards common goals and establish agreement around intended outcomes/results access and adjust the organization´s direction in response to a changing environment.
The efforts put in health planning are initiated by either the state or local government agencies (The Ministry of Health), through implemented legislation or private or non-governmental organizations. As a result, a variety of state health policy makers have designed to: enhance the quality of care, provide and control the access of care (through hospital survey), and contain cost (health insurance) (Swayne, Duncan, & Ginter, 2006).
MEDIUM TERM MEASURES:-
Improving Occupational Health in a Work Place:
The working condition of nurses are likely associated to the quality of care provided to patients and patients’ safety. This is also linked with the health and safety outcomes for nurses and other healthcare providers (Geiger-Brown J; Lipscomb J, 2010).
According to the 2005 survey by the National Institute of Statistics, more than half of the people working in Romania reported poor working conditions in the healthcare sector (European Observatory of Working Life, 2006). It has been statistically proven that nurses endanger themselves with the risk of exposure to infectious diseases, physical violence, ergonomic injuries related to the movement and repositioning of patients, exposure to hazardous chemicals and radiologicals, and sharp object related injuries. These risk threats could be avoided by the appropriate use of technology, environmental controls, and protective equipment. nurses are revoked in accessing these health cautions. It is upon the ministry of health, and private healthcare facilities to provide adequate workplace safeguards, enforce protective procedures, educate staff regarding the risks, provide protective equipment, utilize safety engineered sharps, and cooperate with research into actual and potential risk (American Nurses Association , 2007).
The code of practice for recruitment of international health personnel by WHO encourages countries to receive emigrant healthcare workers to assist in improving working conditions in developing countries. This has proven efficient mechanism for healthcare institutes. This is an economical advantage for the country as it increases the revenue per capita (Annalee Yassi, 2009).
The government should advocate some support provided for these initiatives, however, there should be collaboration between WHO, the International Labour Organization, the International Commission on Occupational Health, and the International Social Security Association and Public Services International (this is a representative for public sector trade unions) Romania would have a genuine responsibility to reciprocate with their resources as beneficiaries of healthcare worker migration. At university level, researchers and practitioners can contribute to the exchange of knowledge by aligning with their colleagues from other low-income countries (WHO, 2009).
To assure the development of information system, it is significant to promote evidence-based decision making, and share information with those who can benefit from it (integration of worker safety and patient safety). This will aid in sharing jurisdiction. That way, millions of dollars won’t be spent annually to design, implement and maintain different systems that could be distributed and reproduced easily. To achieve this, there has to be an international agreement to reach consensus on data dictionary; establish programming of non-proprietary information system which can be tailored to different mechanical environment made available for easy licensing; train health and safety committees ( focusing on occupational health and infection control) to conduct workplace audits, use the information system and implement appropriate prevention mechanisms; conduct campaign studies to evaluate and refine approaches to improve working conditions among healthcare workers (Weerdta & Baratta, 2005).
Introduction to International Strategy:
The involvement of the state is essential to provide adequate workforce in any situation involving two sides of an equation; demand and supply regarding the workforce of health professionals. There are limitations and opportunities that apply to both aspect (Barriball L, 2015).
The government should be involved in the planning and managing of a healthcare sector because they have the power to sign a treaty among other EU countries (National Rural Health Alliance, 2008). For example; the WHO Assembly adopted the WHO Global Code of Practice on international recruitment of healthcare personnel in May 2010. This sketches a voluntary principle for ethical international recruitment, with the intend for improving the authorized and institutional framework for the enrollment practices (WHO, Managing health workforce migration - The Global Code of Practice, 2010).
As a result, the unilateral contract provides an extra tool for implementing the principles of the Code. Such agreement recognizes the need of the country to monitor the extent of migration and its impact on the country’s economy to ensure sufficient training and strategies for financial support to the health system (Global Health Workforce Alliance, 2008).
SHORT TERM MEASURES
Training of Healthcare Workers:
Hospitals should reintroduce demanding programs to train nurses in their specialties. This contributes in retaining nurses who are seeking for a transfer opportunity as well as recruiting new staff. It also establishes career development path for staff. These training are not inexpensive and nursing governance must be ready to justify the proposed budget. Given the cost of temporary staff, this aids as a logical solution for the organization’s leadership to approve (Watkins, 2005).
Shared Governance and Leadership:
This facilitates a steady condition in a healthcare environment. Reports done on magnet hospitals has proven that organizational characteristics that attract and retain nurses include professional practice models for care delivery with autonomy and responsibility for decision-making (Sebai, 2015).
Hence, effective administrative structure is significant for patient care quality, and investment in professional development of nurses. There must be an involvement of staff in defining and developing the practice of care in the institution due to their closeness with patients; In inclusive with participation in the financial management of their unit (Nevidjon & Erickson, 2001).
Introduction of Emergency Medical Services(EMS)
This is a comprehensive system that provides the arrangements of personnel facilities and equipment for the effective, coordinated and efficient delivery of health and safety services to victims of sudden illness or injury (Moore, 1999). This is essential for providing timely care to patients with life threatening emergencies to avoid unnecessary mortality or long-term morbidity (J & AL., 2002).
EMS is a job opportunity for nurses, as it is a mechanism to decrease the rate of emigration in Romania. Recent studies show that nurses are dissatisfied with the role of coordinating care. It is important that nurses are assigned to positions they are trained to. This prevents them from being overwhelmed with work load (DK, McNeese-Smith, 1999).
Reduction in patients´ length of stay.
The supply of nurses is not adequate to meet the current demand and the shortage is projected to grow more severe as future demand increases and nursing schools are not able to keep up with the increasing educational demand. Example of demand of nurses is the length of patients’ stay. As a result, hospital nurses today take care of patients who are sicker than in the past; therefore, their work is more intensive (Héctor Bueno, Joseph S. Ross, & Yun Wang, 2010). Research studies show that heavy workloads among nurses adversely affect patient safety. Furthermore, it negatively affects nursing job satisfaction, and as a result, contributes to higher turnover, and shortage in nurses (Clarke, 1996).
In addition to the higher patient acuity, work system factors and expectations also contribute to the nurses´ workload. Nurses are expected to perform non-professional tasks such as; delivering and retrieving food trays, housekeeping duties, transporting patients, and ordering, coordinating or performing ancillary services (Patricia W. Stone*, 2004). Certain establishment should be earned to reduce the workload of nurses like; unit level, job level, patient level, and situation level (Stone, Clarke, Cimiotti, & Correa-de-Araujo, 2004).
These measures lead to better communication between nurses and their patients, and also set an organized program for the nurses. Example; in a clinical unit, numerous nursing tasks need to be performed by a group of nurses during a specific shift (unit level workload). The type and amount of workload of nurses is partly determined by the type of unit and specialty. Example; intensive care unit (ICU), nurse versus general floor nurse (job level workload). When nurses perform their job, they encounter situations and patients (National Academy of Sciences, 2004).
Improving Data Collection:
According to Diallo, having reliale and valid data about health workforce is a key to better managment and planning. This acknowledges the difficulties in finding accurate data, and he recommends a process of triangulation of different sources to give the most comprehensive overall picture (Diallo K, 2004) .
For example; data can prove the significance of non-finanacial incentives in other developing countries. Such countries in Afrca. This can be adopted by the state in Romania, to improve their law enforcement in the healthcare system. Due to the underinvestment of the countries’resources, there has been a decrease in the wages, as well as working conditions (korte et al).
Studies have proven the effectiveness of non-financial incentives which include, training study leave, opportunites to work in teams, support and feedback from supervisors. As result, the performance of our healthcare practitioners will increase due to the enhancement of their job satisfaction (Stilwell B, 2001).
It is important that the country has an auditor who maintains and keeps records of the performance of the healthcare system. This will help in determing the flaws of the actions authorised by the state to improve the healthcare organizations.
Raising funds for the health system.
Reducing financial barrier to access through prepayment and subsequent pooling of funds in preference to direct out of-pocket.
Allocating or using funds in a way that promotes efficiency and equity.
Health system stewards must, therefore, seek ways to influence the motivations and behaviors of multiple actors and their diverse agendas, finances and organizational structures forming coherent arrangements for health system accountability.
There should be adequate supply of Emergency Medical Services (EMS).
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